As our healthcare system moves from compensating providers on the basis of quantity of care to quality of care, it’s very important to measure hospital performance. But a key limitation for that measurement is patient selection.
A large body of research suggests that it doesn’t matter where patients go for treatment. Teaching hospitals, for example, have been found to achieve modestly better health outcomes. Unfortunately, patients in worse health tend to choose or are referred to hospitals based on the facilities’ capabilities. So hospitals with higher levels of treatment intensity – meaning teaching hospitals or hospitals that perform the latest procedures – could appear to have poorer grades on healthcare report cards because they are treating the sickest patients.
As the debate about health care costs swirls, I’ve published an article that challenges the common view that higher healthcare spending is not correlated with better health outcomes. To the contrary, I found that tourists who become ill and receive emergency care at “high-spending” hospitals have significantly lower mortality rates compared to tourists who end up in “lower-spending” hospitals.
Because hospitals in general tend to spend more on sicker patients, I knew how difficult it is to estimate returns to healthcare spending. My goal was to compare apples to apples. It’s not possible to conduct a randomized experiment where some patients go to a high-spending hospital system and others are sent to a low-spending one. Since most people don’t choose their vacation destinations based on the budgets of local hospitals, tourists come close to mimicking this type of random assignment: some are exposed to high-spending hospital systems while others are exposed to low-spending ones.